The purpose of this section of our site
is to provide an information guide for women suffering from pelvic
organ prolapse who are considering laparoscopic prolapse repair.
For many women, prolapse can include descent
of the uterus, vagina, bladder and/or rectum resulting in a “buldging”
sensation within the vagina. In some cases, frank protrusion of
these organs can occur.
Pelvic organ prolapse can result in symptoms
including urinary leakage, constipation, and difficulty with intercourse.
Laparoscopic colposuspension is a minimally
invasive surgical technique that provides a safe and durable method
for reconstruction of the pelvic floor and its contents without
the need for a large abdominal incision.
Laparoscopic colposuspension is performed
by a team of urologist including Dr. E. James Wright, and Dr. Mohamad Allaf.
To make an appointment for consultation
at Bayview Medical Center, please call 410-550-7008.
To make an appointment for consultation
at Johns Hopkins Hospital, please call 410-955-6100.
For directions to Johns Hopkins
Bayview Medical Center please click
PRIOR TO THE SURGERY
What to expect during you preoperative
During your preoperative
consultation, your surgeon will review your medical history
and perform a physical examination. If your surgeon decides
that you are a candidate for laparoscopic colposuspension,
you will then meet with Mrs. Chanda Nelson to schedule a
date for your operation. She will review the paperwork and
blood tests that you will need prior to surgery. Any scheduling
changes can be made directly through her at 410-550-0412.
It is the responsibility
of the patient to inform Mrs. Nelson of any scheduling changes/cancellations
at least 4 weeks in advance of the surgery date out of courtesy
to your surgeon, the operative staff, as well as other patients.
All billing and insurance inquiries are handled by
Ms. Laura Wheeler at 410-550-3339.
What to expect prior to
the surgery As most insurance companies will not permit patients
to be admitted to the hospital the day before surgery to have
tests completed, you must make an appointment to have pre-operative
testing done at your primary care physician's office within
1 month prior to the date of surgery. Once your surgical date
is secured, a letter will be faxed to your primary care physician
requesting the following pre-operative testing:
- Physical exam
- EKG (electrocardiogram)
- CBC (complete blood count)
- PT / PTT (coagulation profile)
- Comprehensive Metabolic Panel
These results need to be
faxed by your doctor's office to the Pre-operative
Evaluation Center at 410-550-1391 between 1-2 weeks
prior to your surgery date.
Drink only clear fluids for a 24-hour
period prior to the date of your surgery
Remember not to eat or drink anything after
midnight the evening before your surgery.
Clear liquids are liquids that you are able to see through.
Please follow the diet below.
- Clear Broths (no cream soups, meat,
- Juices (no orange juice or tomato
- Apple juice or apple cider
- Grape juice
- Cranberry juice
- Hawaiian punch
- Kool Aid
- Gator Aid
- Tea (you may add sweetener, but no cream
- Coffee (you may add sweetener, but no
cream or milk)
- Clear Jello (without fruit)
- Popsicles (without fruit or cream)
- Italian ices or snowball (no marshmallow)
Do not eat or drink anything after
midnight the night before the surgery. Certain medications
can be taken with a sip of water the morning of surgery.
Asprin, Motrin, Ibuprofen, Advil,
Alka Seltzer, Vitamin E, Vioxx, Plavix, Ticlid, Coumadin,
Lovenox, Celebrex, Voltaren and some other arthritis medications
can cause bleeding and should be avoided 1 week prior to the
date of surgery.
Drink one bottle of magnesium citrate liquid
on the evening before surgery (approximately 4-5 pm) and administer
a fleets enema at home the morning of surgery
to help evacuate the bowel contents. These items may be purchased
over the counter at any pharmacy.
is performed using fine laparoscopic instrumentation inserted
through 4 keyhole incisions across the mid abdomen (Figure
This is in contrast to
the conventional open abdominal colposuspension where a lower
midline (Figure 2a) or Pfannenstiel (Figure 2b) abdominal
incision is required.
In cases of pelvic organ
prolapse, there is laxity of vaginal support resulting in
protrusion of the pelvic organs. The goal of laparoscopic
colposuspension is to resuspend the vagina and associated
pelvic organs through the key-hole incisions. In certain circumstances,
a simultaneous hysterectomy, bladder suspension, or rectocele
repair may be required, all of which can be accomplished through
a vaginal approach.
is a well established procedure at Johns Hopkins Bayview Medical
Center and is performed with the assistance of an experienced
and dedicated laparoscopic surgical team including nurses,
anesthesiologists, operating room technicians, many of whom
you will meet the day of surgery.
is performed through 4 small keyhole (0.5-1 cm) incisions
across the mid abdomen (Figure 1). Through these small incisions,
fine laparoscopic instruments are inserted to dissect and
suture. Excellent visualization of the pelvic organs is achieved
with the use of a high-powered telescopic lens attached to
a camera device, which is inserted into one of the keyhole
The vagina and pelvic organs
are then resuspended internally with a combination of sutures
and a supportive mesh or fascial graft (Figure 3). If needed,
a bladder suspension, vaginal hysterectomy, and rectocele
repair can be accomplished at the same time via a vaginal
incision. A Foley catheter (i.e. bladder catheter) is placed
to drain the bladder. A gauze vaginal packing is also placed
at the end of the procedure.
Schematic sagittal view of laparoscopic colposuspension with
The length of operative
time for laparoscopic colposuspension can vary greatly (3-5
hours) from patient to patient depending on the internal anatomy,
shape of the pelvis, weight of the patient, and presence of
scarring or inflammation in the pelvis due to infection or
prior abdominal/pelvic surgery.
Blood loss during laparoscopic colposuspension is routinely
less than 200 cc and transfusions are rarely required.
Potential Risks and Complications
Although laparoscopic colposuspension
has proven to be very safe, as in any surgical procedure there
are risks and potential complications. Potential risks include:
- Bleeding: Although blood loss during
this procedure is relatively low compared to open surgery,
a transfusion may still be required if deemed necessary
either during the operation or afterwards during the postoperative
- Infection: All patients are treated
with intravenous antibiotics, prior to the start of surgery
to decrease the chance of infection from occurring within
the urinary tract or at the incision sites.
- Adjacent Tissue / Organ Injury: Although
uncommon, possible injury to surrounding tissue and organs
including bowel, vascular structures, pelvic musculature,
and nerves could require further procedures. Transient injury
to nerves or muscles can also occur related to patient positioning
during the operation.
- Hernia: Hernias at the incision sites
rarely occur since all keyhole incisions are closed under
direct laparoscopic view.
- Conversion to Open Surgery: The surgical
procedure may require conversion to the standard open operation
if extreme difficulty is encountered during the laparoscopic
procedure (e.g. excess scarring or bleeding). This could
result in a standard open incision and possibly a longer
- Urinary Incontinence: Pre-existing urinary
incontinence will typically be addressed at the time of
surgery with a bladder sling suspension, however, minor
incontinence may still exist, which typically resolves with
time. On occasion, medication may be required.
- Urinary Retention: As with urinary incontinence,
postoperative urinary retention is uncommon and usually
is present in patients who undergo concurrent bladder sling
suspension. Temporary intermittent self-catheterization
may be required postoperatively.
- Vesicovaginal fistula: A fistula (abnormal
connection) between the bladder and vagina is a rare complication
of any pelvic surgery involving the vagina, uterus, and
bladder. A vesicovaginal fistula typically manifests with
symptoms of continuous urinary leakage from the vagina.
Although rare, these fistulas can be managed conservatively
or by surgical repair through an vaginal incision.
WHAT TO EXPECT AFTER
What to expect
after the surgery
Immediately after the
surgery you will be taken to the recovery room, then transferred
to your hospital room once you are fully awake and your
vital signs are stable.
- Post Operative Pain: Pain medication
can be controlled and delivered by the patient via an
intravenous patient-controlled analgesia (PCA) pump
or by injection (pain shot) administered by the nursing
staff. You may experience minor transient shoulder pain
(1-2 days) related to the carbon dioxide gas used to
inflate your abdomen during the laparoscopic surgery.
- Bladder Spasms: Bladder Spasms are
commonly experienced as a moderate cramping sensation
in the lower abdomen or bladder and are common after
colposuspension. These spasms are usually transient
and often decrease over time. If severe, medications
can be prescribed by your doctor to decrease the episodes
of these spasms.
- Nausea: You may experience transient
nausea during the first 24 hours following surgery,
which can be related to the anesthesia. Medication is
available to treat persistent nausea.
- Urinary Catheter: You can expect
to have a urinary catheter (Foley) draining your bladder
(which is placed in the operating room under anesthesia)
for approximately 1-2 days after the surgery. It is
not uncommon to have blood-tinged urine for a few days
after your surgery.
- Vaginal Packing: A vaginal gauze
packing is routinely placed at the end of the operation
while the patient is under anesthesia. This packing
will typically be removed the next day.
- Diet: You can expect to have an
intravenous catheter (IV) in for 1-2 days. (An IV is
a small tube placed into your vein so that you can receive
necessary fluids and stay well hydrated; in addition
it provides a route to receive medication.) Most patients
are able to tolerate clear liquids the first day after
surgery, and a regular diet the following day. Once
on a regular diet, pain medication will be administered
by mouth instead of by IV or shot.
- Fatigue: Fatigue is common and should
start to subside in a few weeks.
- Incentive Spirometry: You will be
expected to do some very simple breathing exercises
to help prevent respiratory infections by using an incentive
spirometry device (these exercises will be explained
to you during your hospital stay). Coughing and deep
breathing is an important part of your recuperation
and helps prevent pneumonia and other pulmonary complications.
- Ambulation: On the day after surgery
it is very important to get out of bed and begin walking
with the supervision of your nurse or family member
to help prevent blood clots from forming in your legs.
You can expect to have SCD's (sequential compression
devices) along with tight white stockings on your legs
to prevent blood clots from forming in your legs while
you are lying in bed.
- Hospital Stay: Length of hospital
stay for most patients is 1-2 days
- Constipation: You may experience
sluggish bowels for several days to a week after surgery.
Suppositories and stool softeners may be given to help
with this problem. Taking one teaspoon of mineral oil
and milk of magnesia at home will also help to prevent
What to expect after discharge
from the hospital
- Pain Control: You can
expect to have some incisional discomfort that may require
pain medication for a few days after discharge, and thereafter
Tylenol should be sufficient to control your pain.
- Showering: You
may shower at home. Your incision sites can get wet, but
must be padded dry after showering. Tub baths can soak your
incisions and therefore are not recommended in the first
2 weeks after surgery. You will have adhesive strips across
your incisions. They will either fall off on their own or
can be removed in approximately 5-7 days. Sutures underneath
the skin will dissolve in 4-6 weeks.
- Physical Activity:
Taking daily walks is strongly advised following surgery.
Prolonged sitting or lying in bed should be avoided and
can increase your risk for forming blood clots in the legs
as well as developing pneumonia. Climbing stairs is possible
but should be limited. Driving should be avoided for at
least 2 weeks after surgery. Absolutely no heavy lifting
(greater than 20 pounds) or exercising (jogging, swimming,
treadmill, biking) for six weeks or until instructed by
your doctor. Most patients return to full activity an average
of 3 weeks after surgery.
- Sexual Activity:
If a vaginal incision is required during surgery, the patient
may feel pain during intercourse. Therefore, the patient
should abstain from sexual activity for 4-6 weeks after
- Diet: No restrictions.
Drink plenty of fluids.
You can resume your usual medications after surgery with
the exception of aspirin or other blood thinners, which
can increase the risk of bleeding.
- Follow-up Appointment:
You will need to call soon after your discharge to schedule
a follow up visit for 2 weeks after your surgery with your doctor.